Monday, September 24, 2007

Mental Health Court Research

A friend passes along a story on mental health court evaluations and some links to the latest research, for those of you interested in starting or evaluating such creatures in your state. Here are some of the key grafs from the story:

Dale McNeil, Ph.D., a professor of clinical psychology in the Department of Psychiatry, and Renée Binder, M.D., a professor in residence in the Psychiatry and the Law Program at the University of California, San Francisco, compared 170 criminal defendants who entered the mental health court with 8,067 other offenders who received treatment as usual, consisting of passage through the criminal justice system. All subjects had been diagnosed with some mental illness, and two-thirds were charged with felonies. Defendants selected for diversion included a higher proportion of persons with developmental disabilities or severe mental illness—like schizophrenia, delusional disorder, or bipolar disorder—than the control group.

The researchers used a propensity weighting system to overcome nonrandom assignment and intention-to-treat analysis to include all offenders enrolled in the program, not just those who completed its requirements.

Participation in the mental health court program predicted a longer time before offenders faced any new charge or a new violent charge, wrote McNeil and Binder in the September American Journal of Psychiatry...................These mental health courts may have benefits for society that go beyond just reducing crime. A recent study, described as the first of its kind, of 352 defendants by the RAND Corporation in courts in Pennsylvania, "Justice, Treatment, and Cost," found that participation in the jail-diversion program resulted in an increased use of mental health services and a decrease in jail time during the first year after entry into the program. Higher mental health care costs were almost balanced by the reduced costs for keeping the individual locked up. A two-year follow-up found a "dramatic" reduction in jail costs, although most of that came at the end of the second year, as mental health care costs leveled off.

Steadman agreed with McNeil and Binder that more intensive research is needed to support the case for mental health courts.

"All case studies show promising results," he said. "Now we need to use the same research methods in many different courts and look at for whom mental health courts work. What are their demographics, their social history, and their clinical history?"